Efficient and accurate handling of customer inquiries is particularly important in medical applications, such as for hospitals and clinics. One issue affecting medical applications is prevention of abuse of medical coverage. In examples where an external party pays for remotely provided medical coverage, there is potential for abuse when a covered individual shares access to the remotely provided medical coverage with individuals not covered by the system. In situations where the coverage is provided by telephone, a caller needs to call a teller, and the teller asks private questions that only the caller would know to confirm the caller's identity. However, current implementations may not be able to prevent a caller not covered by a medical policy from pretending to be a medically covered individual. This may occur because the covered party has little incentive to prevent abuse of the request, such as allowing others to use the service in the name of the covered party.
Fraud may also occur using nurse triage phone lines than have been preauthorized by a physician, a medical managed company, a corporation, or other entity. In some existing configurations, the care provider may forward their own patient's phone calls to an outsourced nurse triage. Currently, when a patient calls, the nurse evaluates the patient's symptoms and decides on the required level of care for the patient using medical protocols. The nurse then relays the information about the call to the physician or the paying party so that the paying party may follow up if needed. The physician receives information about the patient phone call and the disposition given to the patient by the nurse. Because the nurse-patient interaction occurs by phone, it is possible that additional callers could use the line, even callers who are not patients of the doctor or covered by the managed care policy or corporate policy. This abuse of nurse lines could become a significant issue if patients could easily request a phone call directly to a nurse without having to make a phone call, such as by using a website or using a mobile electronic device application such as on a smartphone or tablet.
Some existing solutions for prevention of fraud in medical request submissions often include placing a phone call to a nurse to verify information and route the request. Once routed, a medical practitioner may return the phone call to the client to discuss the medical request. Another existing solution includes the user logging into an electronic web portal, submitting a description of the medical request, and requesting a return phone call to address the medical request. However, submitting a medical request return call via an electronic web portal operates similar to leaving a generalized voicemail message, where the message does not result in an immediate response. Unlike phone call to a nurse that may be prioritized or routed according to the urgency of the request, an electronic web portal request routes the return call request into the general electronic medical record, which may not be prioritized or routed until the medical practitioner returns the call and discusses the medical request.